Abstract
SummaryIron deficiency and iron deficiency-associated anemia are common complications in cancer patients. Most iron deficient cancer patients present with functional iron deficiency (FID), a status with adequate storage iron, but insufficient iron supply for erythroblasts and other iron dependent tissues. FID is the consequence of the cancer-associated cytokine release, while in absolute iron deficiency iron stores are depleted resulting in similar but often more severe symptoms of insufficient iron supply. Here we present a short review on the epidemiology, pathophysiology, diagnosis, clinical symptoms, and treatment of iron deficiency in cancer patients. Special emphasis is given to intravenous iron supplementation and on the benefits and limitations of different formulations. Based on these considerations and recommendations from current international guidelines we developed recommendations for clinical practice and classified the level of evidence and grade of recommendation according to the principles of evidence-based medicine.
Highlights
Iron (Fe), an important trace element, plays a vital role in oxygen metabolism, oxygen uptake, and electron transport in mitochondria, energy metabolism, muscle function, and hematopoiesis
In patients with chronic diseases or cancer, iron regulation and homeostasis often are distorted [2]. This may result in insufficient iron supply to erythroblasts with clinical sequelae of iron deficiency such as weakness, fatigue, and impaired physical fitness and wellbeing as well as anemia
absolute iron deficiency (AID) is characterized by both depleted iron stores and insufficient iron supply, while in functional iron deficiency (FID) iron stores are loaded, but the deposited iron is unavailable for the erythroblast and for other iron-dependent processes like oxygen transport
Summary
Iron (Fe), an important trace element, plays a vital role in oxygen metabolism, oxygen uptake, and electron transport in mitochondria, energy metabolism, muscle function, and hematopoiesis. AID is characterized by both depleted iron stores and insufficient iron supply, while in FID iron stores are loaded, but the deposited iron is unavailable for the erythroblast and for other iron-dependent processes like oxygen transport This reduction in disposable iron (functional iron deficiency) is mainly mediated by increased hepcidin serum levels, which suppresses the release of adequate quantities of iron into the circulation and which inhibits enteral iron absorption For treatment of anemia in cancer patients three principal options are available, namely red blood cell transfusions (RBC), erythropoiesis-stimulating agents (ESA), and iron. The latter two treatments can be combined to enhance the effectiveness of either one. In this formulation, iron is bound to a matrix which prevents excessive release of free iron
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